scholarly journals Characteristics, Social Factors, and Trends in HIV and AIDS-Related Lymphoma: A 23-Year Analysis Since the Implementation of c ART, a County Hospital AIDS Malignancy Project (CHAMP) Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2304-2304
Author(s):  
Camille E. Demarco ◽  
Pei Lu ◽  
David F. Peace ◽  
Sunny Singh ◽  
Dennis F. Angelov ◽  
...  
Keyword(s):  
Drug Use ◽  
Inner City ◽  
Social Factors ◽  
Survival Data ◽  
B Cell Lymphoma ◽  
Hiv And Aids ◽  
Cancer Type ◽  
Hiv And Cancer ◽  
Over Time ◽  
Hiv Aids

Abstract Introduction: Stroger Hospital (CCH) and the Ruth M. Rothstein CORE Center (CC) are the largest health providers for HIV+ patients (pts) in Chicago and one of the largest HIV clinics in the United States. CCH/CC treat approximately 5,000 HIV+ individuals per year and 40 newly diagnosed HIV-associated cancers annually. The CHAMP Study was originally a retrospective database from 1990 to 2010 of all clinical, demographic, cancer characteristics of pts diagnosed with HIV/AIDS. Since then, the study has compiled data prospectively on all pts with hematological malignancies. In this study, we analyzed various characteristics of pts with HIV/AIDS diagnosed with lymphoma as well as changes seen over time including therapy response since the implementation of combined anti-retroviral therapy (cART). In addition, we assessed variables including drug use, psychiatric history (hx) and time of HIV diagnosis (dx) with respect to cancer presentation. While large population studies of HIV and cancer exist, few studies specifically examine the largest growing HIV demographic, the inner-city HIV population. Methods: Patient's HIV and cancer clinical, laboratory, and survival data were compiled from the CHAMP database. Psychiatric hx and social factors including drug use and time of HIV dx were also analyzed by retrospective chart review and compared between racial and gender groups as well as differences and overall survival (OS). Survival data was examined using Kaplan-Meier analysis and Cox Proportional Hazards model. Statistical comparisons between different groups were performed via the Fisher's exact test. Results: Between 1995-2018, 226 lymphoma pts were identified spanning 26 diagnoses. Fifty-nine percent, 28%, and 11% were African American (AA), Hispanic, and Caucasian, respectively. The cohort was 87% male. The median age by disease ranged from 35-45. Categorized by cancer type; 32% were diffuse large B-cell lymphoma (DLBCL; n=72), 22.5% classic Hodgkin lymphoma (cHL; n=32), 13% Burkitt lymphoma (BL; n=29), 6.7% primary CNS lymphoma (PCNSL; n=15), and 5% plasmablastic lymphoma (PBL; n=11). Seventy-eight percent of pts presented with stage III/IV disease. CD4+ T cell count (CD4) at dx varied by disease, with the median CD4 count ranging from 19 for PCNSL to 260 cells/µL in cHL. DLBCL pts treated with DAEPOCHR (n=23) had a 5-year OS of 80% vs. 68% treated with CHOPR (n=35; p=0.4). cHL had a 5-year OS of 76%. PBL and BL had a 10-year OS of 62% and 58%, respectively. Cases of cHL decreased from 48% of all lymphomas in 2012 (n=8) to 9% in 2017 (p<0.01) while the incidence of BL dropped from 38% in 2004 to 0-10% in 2015-2017. PBL was diagnosed only twice before 2013 to on average of 20% of all lymphomas diagnosed from 2014-17. As a whole, 22% of pts were diagnosed with HIV/AIDS at time of lymphoma dx. Moreover, 13/21 (62%) of Hispanics, 9/41 (22%) AA and 3/11 (30%) Caucasians (p<0.007) with DLBCL and 5/6 (83%) Hispanic vs. 3/18 (18%) AA pts with BL were diagnosed with HIV/AIDS at dx (P<0.007). While Hispanics with DLBCL were more likely to be diagnosed with HIV at lymphoma dx, there was no difference in OS at 5 years, 76% vs. 75%, when stratified by those presenting with compared to those without a known hx of HIV infection. Furthermore, 11/43 (26%) AA DLBCL pts had a hx or known psychiatric disorder compared to 0/20 (0%) Hispanic pts (p<0.037). Men 26/59 (44%) vs. 8/10 (80%) women DLBCL pts had hx of known drug use (p=0.036). No difference in OS by drug use, type of drug, alcohol use, or psychiatric hx was identified in the DLBCL cohort. Conclusions: HIV/AIDS-associated lymphoma in the inner-city remains an AA, male dominated disease, a clear disparity compared to the US HIV/cancer population. Dissimilar to national trends, a statistical decrease in cases of cHL and BL has been noticed over time with a concomitant elevation in PBL. Outcomes for DLBCL were improved with DAEPOCHR compared to CHOPR. Wh en analyzed by race, the majority of Hispanics with lymphoma were diagnosed with HIV at the time of dx, statistically significant, over AA and Caucasians. AA also demonstrated a statistically significant increase in psychiatric hx compared to other races. These findings could explain why 78% of our lymphoma cohort present with advanced stage disease. Combining efforts in prevention/screening of HIV and drug use and providing psychological interventions could help improve outcomes for Hispanics and AA beyond that made with improved therapies. Disclosures No relevant conflicts of interest to declare.

scholarly journals A Wider Range of Conditions Contributing to Death in a Cohort of People Who Have Injected Drugs. Findings from an Edinburgh Cohort.

2020 ◽  
Author(s):  
Roy Robertson ◽  
Lorraine Copeland ◽  
James McKenzie
Keyword(s):  
Drug Use ◽  
Cause Of Death ◽  
Premature Death ◽  
Clinical Situation ◽  
Drug Deaths ◽  
National Mortality ◽  
Wide Range ◽  
Antiviral Chemotherapy ◽  
Over Time ◽  
Hiv Aids

Abstract BackgroundThe morbidity and mortality attributed to injecting drug use is a substantial contributor to any study on causes of premature death. Understanding the extent of this may be limited by difficulties in observing and recording outcomes over several decades. Historic studies have recorded information in a period when blood borne virus and drug deaths were a smaller proportion or, in the cases of Hepatitis C and HIV/AIDS, absent from National mortality figures.Design and settingA cohort of people who had, ever, injected drugs was established over a prolonged period of observation in one, community based, medical practice in Edinburgh (UK). Outcomes were measured in the clinical situation and by accessing death certificates from national, UK, registers.FindingsCauses of death in a cohort of 794 people who inject drugs (PWIDs) varied over time, some conditions relating to single pathological diagnoses and others were more complicated, multimorbid, and cumulative over time. HIV/AIDS was a striking cause of death until 1995 when antiviral chemotherapy was introduced. Drug related deaths (mainly overdose) remained a significant cause of death and death due to alcohol, respiratory, cardiovascular and cancer (mainly lung) increased over time. A wide range of other causes including suicide and violence and trauma were recorded.ConclusionsMortality resulting from present or historic drug use may be underestimated in current recoding systems, which largely record deaths from overdose or a single pathological event in an acute situation. The range of conditions causing or contributing to premature death is enormous reflecting multiple risks associated with drug use.

scholarly journals Prognostic Markers in Cardiac Non-Hodgkin Lymphoma: A Retrospective Review

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5007-5007
Author(s):  
Max J Gordon ◽  
Alexey V. Danilov
Keyword(s):  
T Cell ◽  
B Cell ◽  
Median Survival ◽  
Survival Data ◽  
Cardiac Involvement ◽  
De Novo ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Hiv Aids

Abstract Introduction: Cardiac involvement by Non-Hodgkin lymphoma (NHL) occurs by several distinct mechanisms: primary extra-nodal disease, direct extension, hematogenous or lymphatic spread. While it is not an uncommon autopsy finding, it is rarely deemed to be clinically significant. By contrast, extranodal involvement by NHL is associted with inferior outcomes. Here we performed a retrospective review of 91 published cases of NHL with biopsy-proven cardiac disease to evaluate its clinical significance and impact on outcomes. Methods: A literature search using Pubmed was performed between 1990 and 2015. Inclusion criteria were biopsy proven lymphoma, age greater than or equal to 18, no history of bone marrow transplant and direct involvement of the pericardium and or myocardium. Survival data was only analyzed from patients without HIV/AIDS. Log-rank (Mantel-Cox) test was used to calculate survival. Age comparisons were calculated using an unpaired t-test with a two-tailed p-value and one-way ANOVA. Results: Ninety-one cases met inclusion criteria for the review. The mean age was 55 years (range 19-90 years). Patients with Burkitt lymphoma and HIV/AIDS were younger (p=0.016). Of patients with pathological evidence of cardiac involvement, diffuse large B-cell lymphoma (DLBCL) was the most common NHL subtype (52% of cases), followed by T-cell lymphoma (16%), Burkitt Lymphoma (8%) and small lymphocytic lymphoma (SLL, 6%). Chest pain was the most frequent presenting symptom (Table). Table. N=91 (%) Age: 18-60 >60 (60-90) 48 (53) 43 (47) Sex: Male Female 60 (66) 31 (34) Lymphoma type: Burkitt SLL DLBCL Follicular T-Cell Not specified 8 (9) 6 (7) 52 (57) 2 (2) 15 (16) 8 (9) Treatment: Chemotherapy Chemo and radiation Radiation Surgery None Unreported 25 (28) 6 (6) 1 (1) 4 (4) 11 (12) 44 (49) HIV/AIDS: Infected Non-infected 17 (19) 74 (81) Presenting clinical syndrome: Arrhythmia Chest pain CHF/Dyspnea Constitutional symptoms SVC syndrome Heart Block Stroke Sudden Death Other Unreported 2 (2) 10 (12) 31 (34) 6 (7) 4 (4) 4 (4) 3 (3) 3 (3) 8 (9) 20 (22) Forty-eight patients had primary cardiac lymphoma, which was defined as de novo lymphomatous involvement confined to the myocardium and/or pericardium, 41 patients had secondary disease and two were indeterminate. Patients with primary cardiac lymphoma were older (60 years, 95% CI, 55-59 years, versus 50 years, 95% CI, 47-53 years, p=0.006). Survival data were available for 54 patients. Of note, ~50% of patients did not receive therapy. Median survival was 3 months for all patients. The median survival of patients with T-cell lymphoma was 2 months, versus 4 months in the B-cell lymphoma subgroup (p=0.20). The median survival of patients with indolent B-cell lymphoma (SLL) was 37.5 months versus 4 months in patients with aggressive lymphoma (DLBCL and Burkitt, p=0.77). We found that female sex was associated with a trend towards improved outcome (median survival of 12 versus 3 months, p=0.63). Furthermore, patients diagnosed with primary (de novo) cardiac lymphomas also had better survival, 4 versus 2 months (p=0.23), possibly reflecting the more aggresive nature of relapsed disease. On further analysis, patients who were alive one month after diagnosis had a median survival of 18 months versus 3 months for all patients in this cohort (p=0.032). Furthermore, patients with primary B-cell lymphoma had superior survival to patients with T-cell lymphoma and/or secondary disease (median survival not reached vs 2.5 months, p=0.027). We also found that patients who received chemotherapy had a median survival of 18 months versus 1 month for those who did not (p=0.003). Discussion: Symptomatic cardiac involvement by NHL is rare. While it appears to be more common in DLBCL, it is seen across multiple indolent and aggressive NHL subtypes and is more common in men, typically presenting in the 6th decade of life. The outcomes of patients with NHL with cardiac involvement are poor, particularly among those with aggressive subtypes. However, patients who are candidates for chemotherapy and who survive beyond one month, particularly those with de novo (primary) cardiac B-cell lymphoma, are more likely to achieve long-term survival. Pathological lymphomatous involvement of cardiac tissue needs to be considered as part of differential diagnosis during work-up of patients with NHL. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Boom Province: A Syndemic Approach to the HIV/AIDS Explosion among Aboriginal Persons in Urban Saskatchewan

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Andrea Paige Cessna
Keyword(s):  
Drug Use ◽  
Inner City ◽  
Injection Drug Use ◽  
Structural Violence ◽  
Economic Systems ◽  
Colonial History ◽  
Aids Epidemic ◽  
Aboriginal Women ◽  
The Relationship ◽  
Hiv Aids

The correlation between poverty and the increasing number of HIV/AIDS cases is striking in Saskatchewan’s urban centres. Recent research indicates that the current spike of HIV/AIDS cases in the province disproportionately affects young Aboriginal women who live in Saskatoon’s inner-city neighbourhoods. Because HIV/AIDS is both a pathological and social reality, this paper uses a syndemic approach to analyze coinfection, injection drug use, poverty, gender, and ethnicity/race as they pertain to the emerging HIV/AIDS epidemic in Saskatchewan. Taking into consideration Canada’s colonial history and ongoing neo-colonialism facing Aboriginal persons, this paper explores the relationship between health configurations and larger political and economic systems that result in structural violence.

Domestic Integration and Suicide in the Provinces of Canada

Crisis ◽  
1999 ◽  
Vol 20 (2) ◽  
pp. 59-63 ◽  
Author(s):  
Antoon A. Leenaars ◽  
David Lester
Keyword(s):  
Social Factors ◽  
Positive Association ◽  
Negative Association ◽  
Birth Rates ◽  
Marriage Rates ◽  
Suicide Rates ◽  
The Social ◽  
Divorce Rates ◽  
Low Levels ◽  
Over Time

Canada's rate of suicide varies from province to province. The classical theory of suicide, which attempts to explain the social suicide rate, stems from Durkheim, who argued that low levels of social integration and regulation are associated with high rates of suicide. The present study explored whether social factors (divorce, marriage, and birth rates) do in fact predict suicide rates over time for each province (period studied: 1950-1990). The results showed a positive association between divorce rates and suicide rates, and a negative association between birth rates and suicide rates. Marriage rates showed no consistent association, an anomaly as compared to research from other nations.

scholarly journals EPID-36. ANTIDEPRESSANT DRUG USE IN GLIOBLASTOMA PATIENTS: AN EPIDEMIOLOGICAL VIEW

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii86-ii86
Author(s):  
Dorothee Gramatzki ◽  
James Rogers ◽  
Marian Neidert ◽  
Caroline Hertler ◽  
Emilie Le Rhun ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Drug Use ◽  
Survival Data ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Methylation Status ◽  
Antidepressant Drug ◽  
Antidepressant Drugs ◽  
Population Level ◽  
Disease Course

Abstract PURPOSE Antidepressant drugs have shown anti-tumor activity in preclinical glioblastoma studies. Antidepressant drug use, as well as its association with survival, in glioblastoma patients has not been well characterized on a population level. METHODS Patient characteristics, including the frequency of antidepressant drug use, were assessed in a glioblastoma cohort diagnosed in a 10-year time-frame between 2005 and 2014 in the Canton of Zurich, Switzerland. Cox proportional hazards regression models were applied for multivariate analysis. Kaplan-Meier survival curves were used to estimate overall survival data and the log-rank test was performed for comparisons. RESULTS Four hundred four patients with isocitrate dehydrogenase (IDH) wildtype glioblastoma were included in this study. Sixty-five patients (16.1%) took antidepressant drugs at some point during the disease course. Patients were most commonly prescribed selective serotonin reuptake inhibitors at any time (N=46, 70.8%). Nineteen patients (29.2%) were on antidepressant drugs at the time of their tumor diagnosis. No differences were observed in overall survival between those patients who had taken antidepressants at some point in their disease course and those who had not (p=0.356). These data were confirmed in a multivariate analysis including age, Karnofsky performance status, gender, extent of resection, O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status, and first-line treatment as cofounders (p=0.315). Also, there was no association of use of drugs modulating voltage-dependent potassium channels (citalopram; escitalopram) with survival (p=0.639). CONCLUSIONS This signal-seeking study does not support the hypothesis that antidepressants have antitumor efficacy in glioblastoma on a population level.

scholarly journals Use of pembrolizumab with or without pomalidomide in HIV-associated non-Hodgkin’s lymphoma

2021 ◽  
Vol 9 (2) ◽  
pp. e002097
Author(s):  
Kathryn Lurain ◽  
Ramya Ramaswami ◽  
Ralph Mangusan ◽  
Anaida Widell ◽  
Irene Ekwede ◽  
...  
Keyword(s):  
B Cell ◽  
Hodgkin’S Lymphoma ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Hiv And Aids ◽  
Hodgkin's Lymphoma ◽  
People Living With Hiv ◽  
Oncogenic Viruses ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

BackgroundNon-Hodgkin’s lymphoma (NHL) is currently the most common malignancy among people living with HIV (PLWH) in the USA. NHL in PLWH is more frequently associated with oncogenic viruses than NHL in immunocompetent individuals and is generally associated with increased PD-1 expression and T cell exhaustion. An effective immune-based second-line approach that is less immunosuppressive than chemotherapy may decrease infection risk, improve immune control of oncogenic viruses, and ultimately allow for better lymphoma control.MethodsWe conducted a retrospective study of patients with HIV-associated lymphomas treated with pembrolizumab±pomalidomide in the HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute.ResultsWe identified 10 patients with stage IV relapsed and/or primary refractory HIV-associated NHL who were treated with pembrolizumab, an immune checkpoint inihibitor, with or without pomalidomide. Five patients had primary effusion lymphoma (PEL): one had germinal center B cell-like (GCB) diffuse large B cell lymphoma (DLBCL); two had non-GCB DLBCL; one had aggressive B cell lymphoma, not otherwise specified; and one had plasmablastic lymphoma. Six patients received pembrolizumab alone at 200 mg intravenously every 3 weeks, three received pembrolizumab 200 mg intravenously every 4 weeks plus pomalidomide 4 mg orally every day for days 1–21 of a 28-day cycle; and one sequentially received pembrolizumab alone and then pomalidomide alone. The response rate was 50% with particular benefit in gammaherpesvirus-associated tumors. The progression-free survival was 4.1 months (95% CI: 1.3 to 12.4) and overall survival was 14.7 months (95% CI: 2.96 to not reached). Three patients with PEL had leptomeningeal disease: one had a complete response and the other two had long-term disease control. There were four immune-related adverse events (irAEs), all CTCAEv5 grade 2–3; three of the four patients were able to continue receiving pembrolizumab. No irAEs occurred in patients receiving the combination of pembrolizumab and pomalidomide.ConclusionsTreatment of HIV-associated NHL with pembrolizumab with or without pomalidomide elicited responses in several subtypes of HIV-associated NHL. This approach is worth further study in PLWH and NHL.

“That’s well good”: A Re-emergent Intensifier in Current British English

2020 ◽  
pp. 007542422097914
Author(s):  
Karin Aijmer
Keyword(s):  
Social Class ◽  
Fourteenth Century ◽  
Social Factors ◽  
British English ◽  
Discourse Marker ◽  
Time Gap ◽  
British National Corpus ◽  
Semantic Types ◽  
Over Time ◽  
National Corpus

Well has a long history and is found as an intensifier already in older English. It is argued that diachronically well has developed from its etymological meaning (‘in a good way’) on a cline of adverbialization to an intensifier and to a discourse marker. Well is replaced by other intensifiers in the fourteenth century but emerges in new uses in Present-Day English. The changes in frequency and use of the new intensifier are explored on the basis of a twenty-year time gap between the old British National Corpus (1994) and the new Spoken British National Corpus (2014). The results show that well increases in frequency over time and that it spreads to new semantic types of adjectives and participles, and is found above all in predicative structures with a copula. The emergence of a new well and its increase in frequency are also related to social factors such as the age, gender, and social class of the speakers, and the informal character of the conversation.

Narrating The City: spaces Of Urban Change, South London

2008 ◽  
Vol 33 (2) ◽  
pp. 10-17
Author(s):  
Suzanne M. Hall
Keyword(s):  
Inner City ◽  
The Other ◽  
Urban Change ◽  
Spatial Transformation ◽  
Class Culture ◽  
Relationship Of ◽  
The City ◽  
North And South ◽  
Official Data ◽  
Over Time

This paper explores the documentation of social and spatial transformation in the Walworth area, South London. Spatial narratives are the entry point for my exploration, where official and ‘unofficial’ representations of history are aligned to capture the nature of urban change. Looking at the city from street level provides a worldly view of social encounter and spaces that are expressive of how citizens experience and shape the city. A more distanced view of the city accessed from official data reveals different constructs. In overlaying near and far views and data and experience, correlations and contestations emerge. As a method of research, the narrative is the potential palimpsest, incorporating fragments of the immediate and historic without representing a comprehensive whole. In this paper Walworth is documented as a local and Inner City context where remnants and insertions are juxtaposed, where white working class culture and diverse ethnicities experience difference and change. A primary aim is to consider the diverse experiences of groups and individuals over time, through their relationship with their street, neighbourhood and city. In relating the Walworth area to London I use three spatial narratives to articulate the contemporary and historic relationship of people to place: the other side examines the physical discrimination between north and south London, the other half looks at distinctions of class and race and other histories explores the histories displaced from official accounts.

scholarly journals Outcome of R-CHOP or CHOP Regimen for Germinal Center and Nongerminal Center Subtypes of Diffuse Large B-Cell Lymphoma of Chinese Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Ying Huang ◽  
Sheng Ye ◽  
Yabing Cao ◽  
Zhiming Li ◽  
Jiajia Huang ◽  
...  
Keyword(s):  
B Cell ◽  
Germinal Center ◽  
Survival Data ◽  
Prognostic Value ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Chinese Patients ◽  
First Line ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Diffuse large B-cell lymphoma (DLBCL) can be molecularly subtyped as either germinal center B-cell (GCB) or non-GCB. The role of rituximab(R) in these two groups remains unclear. We studied 204 patients with de novo DLBCL (107 treated with first-line CHOP; 97 treated with first-line R-CHOP), patients being stratified into GCB and non-GCB on the basis of BCL-6, CD10, and MUM1 protein expression. The relationships between clinical characteristics, survival data, and immunophenotype (IHC) were studied. The 5-year overall survival (OS) in the CHOP and R-CHOP groups was 50.4% and 66.6% (P=0.031), respectively. GCB patients had a better 5-year OS than non-GCB patients whether treated with CHOP or not (65.0% versus 40.9%;P=0.011). In contrast, there is no difference in the 5-year OS for the GCB and non-GCB with R-CHOP (76.5% versus 61.3%;P=0.141). In non-GCB subtype, additional rituximab improved survival better than CHOP (61.3% versus 40.9%;P=0.0303). These results indicated that addition of rituximab to standard chemotherapy eliminates the prognostic value of IHC-defined GCB and non-GCB phenotypes in DLBCL by improving the prognostic value of non-GCB subtype of DLBCL.

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